Physical abuse is a leading cause of serious head injury and death in
children aged 2 years or younger. The incidence of inflicted traumatic brain
injury (TBI) in US children is unknown.
To determine the incidence of serious or fatal inflicted TBI in a defined
US population of approximately 230 000 children aged 2 years or younger.
Design, Setting, and Subjects
All North Carolina children aged 2 years or younger who were admitted
to a pediatric intensive care unit or who died with a TBI in 2000 and 2001
were identified prospectively. Injuries were considered inflicted if accompanied
by a confession or a medical and social service agency determination of abuse.
Main Outcome Measure
Incidence of inflicted TBI. Multivariate logistic regression models
were used to compare children with inflicted injuries with those with noninflicted
injuries and with the general state population aged 2 years or younger.
A total of 152 cases of serious or fatal TBI were identified, with 80
(53%) incurring inflicted TBI. The incidence of inflicted traumatic brain
injury in the first 2 years of life was 17.0 (95% confidence interval [CI],
13.3-20.7) per 100 000 person-years. Infants had a higher incidence than
children in the second year of life (29.7 [95% CI, 22.9-36.7] vs 3.8 [95%
CI, 1.3-6.4] per 100 000 person-years). Boys had a higher incidence than
girls (21.0 [95% CI, 15.1-26.6] vs 13.0 [95% CI, 8.4-17.7] per 100 000
person-years). Relative to the general population, children who incurred an
increased risk of inflicted injury were born to young mothers (≤21 years),
non–European American, or products of multiple births.
In this population of North Carolina children, the incidence of inflicted
TBI varied by characteristics of the injured children and their mothers. These
data may be helpful for informing preventive interventions.